Enterocolitis In Preterm Neonates Research Articles

Molecular epidemiology of Clostridium neonatale and its relationship with the occurrence of necrotizing enterocolitis in preterm neonates.

Clostridia—especially Clostridium butyricum—are among the taxa most frequently identified from stool samples of preterm neonates with necrotizing enterocolitis (NEC). Recently, Clostridium neonatale has also been detected from epidemic cases, but using a culture-based approach we were unable to confirm this discovery in a local cohort. In order to investigate this link by a molecular approach, a specific rpoB-based quantitative real-time PCR was developed to detect C. neonatale directly from patients' stool specimens. Design of this rpoB-based quantitative real-time PCR was based on the genomic analysis of seven clinical isolates of C. neonatale. It was tested on stool samples from 88 preterm neonates with necrotizing enterocolitis and 71 matched controls. C. neonatale was significantly more prevalent in stools from preterm neonates with necrotizing enterocolitis than in controls (respectively 30/88 (34%) versus 9/71 (13%); p 0.003). Whole-genome analysis also allowed the identification of three genomic clusters of C. neonatale. This clustering was associated with a geographical location regardless of isolation from the NEC or control, suggesting asymptomatic carriage. Although less prevalent than C. butyricum in our cohort, C. neonatale is significantly associated with the occurrence of necrotizing enterocolitis.

The WHEAT pilot trial—WithHolding Enteral feeds Around packed red cell Transfusion to prevent necrotising enterocolitis in preterm neonates: a multicentre, electronic patient record (EPR), randomised controlled point-of-care pilot trial

IntroductionNecrotising enterocolitis (NEC) is a potentially devastating neonatal disease. A temporal association between red cell transfusion and NEC is well described. Observational data suggest that withholding enteral feeds around red...

Early Doppler Ultrasound in the Superior Mesenteric Artery and the Prediction of Necrotizing Enterocolitis in Preterm Neonates.

The purpose of this study was to reveal the correlation between superior mesenteric artery (SMA) blood flow in the first 12 hours of life and the risk of necrotizing enterocolitis (NEC) in preterm neonates. We conducted a prospective study. There were 104 preterm neonates included in our study. The SMA blood flow of each neonate was measured during the first 12 hours of life if the hemodynamic situation was stable. The results of Doppler ultrasound were confidential to the neonatologists and nurses. All of the demographics, comorbidities, and outcomes were recorded and analyzed. Among all of the demographics and comorbidities, the gestational age was related to the measurements of SMA blood flow. We conducted a single-factor analysis of the occurrence of NEC, including the peak systolic velocity (PSV), end-diastolic velocity, time-averaged mean velocity, differential velocity (DV), resistive index, and pulsatility index. A higher PSV (median [interquartile range], 54.165 [42.423-68.463] versus 42.195 [34.278-48.553] cm/s; P = .027) and DV (median [interquartile range], 47.445 [35.010-60.043] versus 32.565 [27.545-39.073] cm/s; P = .020) were significantly related to the risk of NEC. In the logistic analysis including gestational age, PSV, and DV, NEC was significantly associated with gestational age (odds ratio [95% confidence interval], 0.644 [0.456-0.908]; P = .012) and DV (odds ratio [95% confidence interval], 1.144 [1.058-1.237]; P < .01). The area under the receiver operating characteristic curve for the DV was 0.768, with sensitivity 0.875 and specificity 0.604. The cutoff value of the DV was 34.835 cm/s. From this single-center study, we can see the promising value of Doppler ultrasound for the prediction of NEC, but further research is needed.

Maternal IgA protects against the development of necrotizing enterocolitis in preterm infants.

Neonates are protected from colonizing bacteria by antibodies secreted into maternal milk. Necrotizing enterocolitis (NEC) is a disease of neonatal preterm infants with high morbidity and mortality that is associated with intestinal inflammation driven by the microbiota1-3. The incidence of NEC is substantially lower in infants fed with maternal milk, although the mechanisms that underlie this benefit are not clear4-6. Here we show that maternal immunoglobulin A (IgA) is an important factor for protection against NEC. Analysis of IgA binding to fecal bacteria from preterm infants indicated that maternal milk was the predominant source of IgA in the first month of life and that a relative decrease in IgA-bound bacteria is associated with the development of NEC. Sequencing of IgA-bound and unbound bacteria revealed that before the onset of disease, NEC was associated with increasing domination by Enterobacteriaceae in the IgA-unbound fraction of the microbiota. Furthermore, we confirmed that IgA is critical for preventing NEC in a mouse model, in which pups that are reared by IgA-deficient mothers are susceptible to disease despite exposure to maternal milk. Our findings show that maternal IgA shapes the host-microbiota relationship of preterm neonates and that IgA in maternal milk is a critical and necessary factor for the prevention of NEC.

The relation between serum levels of epidermal growth factor and necrotizing enterocolitis in preterm neonates.

PurposeNecrotizing enterocolitis (NEC) is one of the most serious complications of prematurity. Many risk factors can contribute to the development of NEC. The epidermal growth factor (EGF) plays a major role in intestinal barrier function, increases intestinal enzyme activity, and improves nutrient transport. The aim of this study was to assess the role of epidermal growth factor in the development of NEC in preterm neonates.MethodsIn this study, 130 preterm neonates were included and divided into 3 groups, as follows: group 1, 40 preterm neonates with NEC; group 2, 50 preterm neonates with sepsis; and group 3, 40 healthy preterm neonates as controls. The NEC group was then subdivided into medical and surgical NEC subgroups. The serum EGF level was measured using enzyme-linked immunosorbent assay.ResultsSerum EGF levels (pg/dL) were significantly lower in the NEC group (median [interquartile range, IQR], 9.6 [2–14]) than in the sepsis (10.1 [8–14]) and control groups (11.2 [8–14], P<0.001), with no significant difference between the sepsis and control groups, and were positively correlated with gestational age (r=0.7, P<0.001). A binary logistic regression test revealed that low EGF levels and gestational ages could significantly predict the development of NEC. The receiver-operating characteristic curve for EGF showed an optimal cutoff value of 8 pg/mL, with 73.3% sensitivity, 98% specificity, and an area under the curve of 0.92.ConclusionThe patients with NEC in this study had significantly lower serum EGF levels (P<0.001), which indicated that EGF could be a reliable marker of NEC in preterm neonates.

Role of Melatonin in Treatment of Necrotizing Enterocolitis in Preterm Neonates

AbstractBackground: Necrotizing enterocolitis (NEC) is one of the most dangerous gastrointestinal diseases that affects the neonates especially preterm neonates. It can lead to severe morbidity and even mortality, so early detection of NEC would give us good chance for early prevention and treatment with better prognosis. Free radicals play a significant role in the pathogenesis of neonatal sepsis and NEC. It has been suggested that melatoninas an antioxidant can be used to counteract the toxicity of oxygen radicals that are released during neonatal illness.Aim of Study: Is to Determine the role of melatonin as an adjuvant therapy in treating necrotizing enterocolitis (NEC) in preterm neonates.Patients and Methods: A prospective clinical trial study was conducted on 20 preterm neonates which suffer from NEC diagnosed on the basis of both clinical and laboratory criteria. group (G I) (n=10) received melatonin and antibiotics, while the control group (G II) (n=10) was treated with antibi-otics only. Melatonin was administered as 20 mg for 3 con-secutive days and antibiotics were administered according to a standard protocol protocol and followed-up of symptoms and signs of NEC after 5,10 and 15 days of starting treatment.Results: As regard outcome of NEC, In group I there were 9 (90%) cases improved and 1 (10%) case not improved but In group II there were 5 (50%) cases improved and 5 (50%) cases not improved, so more cases in group I who received melatonin showed improvement of NEC than group II. As regard mortality, one baby (10%) died and 9 (90%) survived in group I compared to 3 babies (30%) died and 7 babies (70%) survived in group II.As regard length of NICU stay the patients who received melatonin (group I) stay for a shorter period in NICU compared to group II who received traditional therapy only.Conclusion: Melatonin administration as an adjuvant therapy in NEC treatment in preterm neonates is associated with improvement of clinical and laboratory outcome.

489: Does antenatal magnesium sulfate exposure increase the risk of necrotizing enterocolitis in preterm neonates?

489: Does antenatal magnesium sulfate exposure increase the risk of necrotizing enterocolitis in preterm neonates?

Plasma citrulline as a diagnostic biomarker for necrotizing enterocolitis in preterm neonates

Plasma citrulline as a diagnostic biomarker for necrotizing enterocolitis in preterm neonates

Microbial Biomarkers of Intestinal Barrier Maturation in Preterm Infants.

Intestinal barrier immaturity, or “leaky gut,” is the proximate cause of susceptibility to necrotizing enterocolitis in preterm neonates. However, the impact of intestinal microbiota development on intestinal mucosal barrier maturation has not been evaluated in this population. In this study, we investigated a longitudinally sampled cohort of 38 preterm infants < 33 weeks gestation monitored for intestinal permeability (IP) and fecal microbiota during the first 2 weeks of life. Rapid decrease in IP indicating intestinal barrier function maturation correlated with significant increase in community diversity. In particular, members of the Clostridiales and Bifidobacterium were highly transcriptionally active, and progressively increasing abundance in Clostridiales was significantly associated with decreased intestinal permeability. Further, neonatal factors previously identified to promote intestinal barrier maturation, including early exclusive breastmilk feeding and shorter duration antibiotic exposure, associate with the early colonization of the intestinal microbiota by members of the Clostridiales, which altogether are associated with improved intestinal barrier function in preterm infants.

Descending Aorta Blood Flow Characteristics before the Development of Necrotizing Enterocolitis in Preterm Neonates

Descending Aorta Blood Flow Characteristics before the Development of Necrotizing Enterocolitis in Preterm Neonates

Serial fecal calprotectin in the prediction of necrotizing enterocolitis in preterm neonates

PurposeTo investigate whether serial measurements of fecal calprotectin concentrations enable us to identify infants who will develop NEC prior to development of symptoms. MethodsProspective matched case–control study including 100 high-risk neonates. High risk includes 1) gestational age (GA) ≤30 weeks, 2) birth-weight (BW) ≤1000 g, 3) GA 30–32 weeks and BW ≤1250 g, 4) born from a mother who received indomethacin for tocolysis. We matched every NEC subject with three controls for birth weight and gestational age. Fecal calprotectin was measured twice a week from day one until five weeks after birth or until NEC development. We analyzed differences in fecal calprotectin between NEC subjects and controls in the week preceding NEC onset and course of fecal calprotectin within subjects who developed NEC. ResultsOf 100 included patients, ten (median GA 27.5 weeks [24.6–29.4], BW 1010 g [775–1630]) developed NEC. The median calprotectin concentration in all samples combined was 332 μg/g [<40–8230] μg/g feces. There were no differences between NEC subjects and controls, with a wide variation in both groups. In NEC subjects, there was no intraindividual rise in calprotectin before clinical symptoms occurred. ConclusionsThere are high concentrations and wide interindividual variations in calprotectin in preterm infants during the first weeks of life. Wide intraindividual variation further precludes the serial use of fecal calprotectin in the early detection or prediction of NEC in high risk infants. Level of EvidenceIII

Role of probiotics in prevention of necrotizing enterocolitis in preterm neonates

Background: Necrotizing enterocolitis (NEC) is one of the common emergencies in preterm neonates which are associated with high morbidity and mortality despite recent advances in neonatal care. Probiotics may be one of the most effective therapies for the prevention of NEC. Objective: The objective of this study is to evaluate the role of probiotics in reducing the incidence of NEC in preterm newborns. Methods: This was a prospective randomized control study conducted at tertiary care teaching hospital. A total of 140 preterm newborns of gestation ?34 weeks of age were enroled in the final analysis. The recruited newborns were randomized into intervention group and control group by simple random sampling method. The intervention group was fed probiotics mixed with expressed breast milk, and the control group was fed with milk alone. Result: The incidence of NEC in probiotics group was significantly lower than in the control group (2.86% vs. 11.43%), (p=0.04). Although there were no significant differences in the initial presentation of NEC between the two groups, those in the study group who developed NEC had less severe disease, based on Bell’s staging criteria. There was no significant difference in terms of age in diagnosis of NEC and in age at which birth weight is gained between the two groups. However, there was a statistically significant difference in duration of hospital stay (15.62±2.84 vs. 23.54±3.43 days; p&lt;0.001) and time to reach full feed (15.82±3.15 vs. 20.22±2.14; p&lt;0.001). There was no significant difference in incidence of overall mortality (p=0.209; relative risk [RR] 0.25, 95% confidence interval [CI]: 0.029–2.18) and sepsis rate (p=0.673; RR 1.15, 95% CI: 0.593–2.243) between the two groups. Conclusion: Probiotics supplementation reduced the incidence and severity of NEC in the preterm neonates. This resulted in shorter duration of hospital stay and faster achievement of full oral feeds.

The Effect of Probiotics in Prevention of Necrotising Enterocolitis in Preterm Neonates in Comparison with Control Group

Background: Necrotizing enterocolitis (NEC) is a common dangerous gastrointestinal emergency in neonatology, especially in premature infants, which can cause serious problems. Objectives: This study was conducted to find out whether administration of probiotics could lead to prevention and/or treatment of NEC. Methods: 115 premature newborns weighting 750 - 1500 g or less than 32 weeks’ gestation were checked daily for NEC signs and weight gain and mean day of full feed achievement was recorded. Results: The incidence of NEC and C-reactive protein (CRP) rise showed a significant difference (P = 0.02) between the two (case and control) groups, but the difference regarding mean duration of oxygen therapy, TPN, full feeding achievement, and hospitalization was not significant. Conclusions: These results showed positive effects of probiotics on preventing and treating NEC, especially NEC grade 3 in ELBW and VLBW neonates.

To study the role of probiotics in the prevention of necrotizing enterocolitis in preterm neonates

Background: Necrotizing enterocolitis is defined as an inflammatory bowel necrosis in premature infants and is major cause of morbidity and mortality in neonatal intensive care units throughout the world. We aim to study the role of probiotics in reducing incidence and severity of necrotizing enterocolitis in preterm neonates ≤34 weeks and its role on secondary outcomes like mortality, time to reach full feeds, daily weight gain, days of hospitalization and effect on nosocomial infections.Methods: This study was a prospective randomized controlled interventional trial conducted in SGRDIMSAR, Amritsar. A sample size of 150 was selected. 75 were randomized to test group and 75 to control group by simple random sampling.Results: The incidence of NEC was significantly lower in the test group compared with the control group (1 of 75 neonates vs 12 of 75 neonates; p=0.001). The severity of NEC, nosocomial sepsis and mean duration of hospital stay was significantly lower in the test group. Daily weight gain was significantly higher in the test group. There was no significant difference in mean age of onset of NEC, mortality and mean age to reach full feeds in two groups.Conclusions: Incidence and severity of NEC was less in the probiotic group. Daily weight gain was better, nosocomial sepsis and mean duration of hospital stay were less in the probiotic group.

Vagal Dysregulation in the First Week of Life is Associated with Markedly Increased Pro-Inflammatory Cytokines and Late Onset Sepsis or Necrotizing Enterocolitis in Preterm Neonates

Vagal Dysregulation in the First Week of Life is Associated with Markedly Increased Pro-Inflammatory Cytokines and Late Onset Sepsis or Necrotizing Enterocolitis in Preterm Neonates

Erythropoietin for prevention of necrotizing enterocolitis in preterm neonates: a systematic review

Erythropoietin for prevention of necrotizing enterocolitis in preterm neonates: a systematic review

Efficacy of Probiotics Versus Placebo in the Prevention of Necrotizing Enterocolitis in Preterm Very Low Birth Weight Infants: A Double-Blind Randomized Controlled Trial.

To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis (NEC) in preterm very low birth weight (VLBW) infants. Arandomized double blind controlled trial. The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet Bangladesh, from July 2012 to June 2015. Preterm (28 - 33 weeks gestation) VLBW (birth weight 1000 - 1499 g) neonates were enrolled. The study group was fed with probiotics once daily with breast milk from first feeding, and the control group with only breast milk without the addition of probiotics. Both the groups received other standard care. The primary outcome was the development of NEC (stage II and III), categorized by modified Bell's classification. In 108 neonates, development of NEC was significantly lower in the study group than that of control group [1 (1.9%) vs. 6 (11.5%); p=0.044]. Age of achievement of full oral feeding was significantly earlier in the study group than that in the control group (14.88 ±3.15 and 18.80 ±4.32 days; p < 0.001). Duration of hospital stay was significantly short in the study group compared to the control group (15.82 ±2.94 days vs. 19.57 ±4.26 days; p < 0.001). Probiotic supplementation reduces the frequency of necrotising enterocolitis in preterm neonates with very low birth weight. It is also associated with faster achievement of full oral feeding and short duration of hospital stay.

Efficacy of Lactobacillus Acidophilus DDS-1, Lactobacillus Bulgaricus, Bifidobacterium Infantis in the Prevention of Necrotizing Enterocolitis in Preterm Neonates

Objectives: To compare the efficacy of combination of lactobacillus acidophilus DDS-1, lactobacillus bulgaricus, bifidobacterium infantis in the prevention of necrotizing enterocolitis in preterm neonates with placebo. Study Design: Randomized controlled trial. Duration of Study: May 2012 to October 2012. Setting: Department of Pediatric Medicine, Allied Hospital, Faisalabad. Methodology: Over 6 months, 220 preterm neonates meeting the inclusion criteria were selected and were assigned randomly to two groups after parental informed consent was obtained. The neonates in study group received probiotic with breast milk or preterm formula milk and neonates in control group received breast milk or preterm formula milk. Both groups were observed for the development of clinical evidence of NEC. The Data was statistically analyzed; Chi square test and Fischer’s exact test was applied to compare both groups for presence of NEC. Results: The number of days required to reach full enteral feeding (study group 8.73±3.87 days vs control group 10.72±5.43 days; p-value 0.002) and duration of hospital stay was (study group 11.35±6.74 vs control group 15.35±10.29; p-value 0.001) significantly low in the probiotic-exposed group compared with the control. The incidence of NEC (study group 10.0% vs control group 22.72%; p-value 0.011) was significantly low in the probiotic-exposed group when compared with non-exposed group. Conclusion: Alteration of microbial florae following oral supplementation of probiotics along with human milk have beneficial effects in reducing the incidence of NEC especially in pre-term neonates.

Probiotics for the Prevention of Necrotizing Enterocolitis in Preterm Neonates

Necrotizing enterocolitis is a life-threatening condition in preterm neonates that is associated with severe morbidity and mortality. Several studies have suggested that probiotics can potentially decrease the risk of developing necrotizing enterocolitis via several proposed mechanisms of action, including increasing diversity of the intestinal flora. However, due to a lack of standardized study designs, including variability in product selection, dose, time of initiation, and duration, as well as a concern for safety in this vulnerable population, the use of probiotics in this population remains controversial. Regulations for testing of products and well-validated dosing regimens are needed before considering routine use of probiotics in these high-risk patients.

517 Vagal Dysregulation and Female Sex Are Risk Factors for Necrotizing Enterocolitis in Preterm Neonates

517 Vagal Dysregulation and Female Sex Are Risk Factors for Necrotizing Enterocolitis in Preterm Neonates